(203) 869-1145

Category: Sports Medicine

For many of today’s young athletes, summer break includes a sports camp providing concentrated training in their specialized sport. But according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky, early sports specialization is the last thing they should be doing with their free time.

“There is an increasing body of evidence indicating that early sports specialization does more harm than good. In fact, it seems that it actually decreases the potential for success in the sport in the long term,” he said.

Dr. Kowalsky said children who specialize in a single sport before the age of 13 don’t develop the protective neuromuscular patterns that help prevent stress to a single area of the body. Because young athletes are less likely to perform technical repetitive skills properly, these children are more prone to overuse injuries that can sideline them later in life.

“The risk of injury doubles for children involved in excessive organized play at early ages over children who participate in an appropriate amount of free play,” Dr. Kowalsky noted.

Children who undergo early sports specialization are also at an increased risk for psychological burnout, which overtime can manifest as mood disturbances, social isolation, and eating disorders. “These kids often drop out of the sport altogether as they get older,” he said.

Despite popular belief, early specialization does not guarantee elite performance later in life. A study of elite adult athletes at amateur and pro levels revealed that elite success did not require exclusive participation in a single sport until their high school years. Instead, top players participated in multiple sports in the preceding years, developing important movement patterns that made them stronger over time.

The trend toward early youth sports specialization is relatively new. Twenty years ago, young athletes typically played a particular sport only during a given season (i.e. football in the fall, baseball in the spring, swimming in the summer), and most kids rested from competitive sports for a season or during the summer.

The surge in throwing injuries, stress fractures, and other overuse injuries in younger athletes reflects the physical pressures affecting today’s young athletic bodies. A recent study found that high school athletes who had trained in one sport for more than 8 months in a year were more likely to report a history of overuse knee and hip injuries, than those who played a variety of sports throughout the year or played sports at less intense levels.

The vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain.

Thankfully, these injuries are relatively easy to treat when recognized early, with a period rest and activity modification. All too often, however, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games.

Left untreated, overuse injuries can lead to more significant structural damage to an affected area, and can therefore require lengthier rehabilitation and sometimes surgery.

What’s more, repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. For instance, significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

“The musculature and bones of the developing thrower are not prepared for the excessive numbers of pitches they throw in a game,” said Dr. Kowalsky. This in part has contributed to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, which sometimes requires the so-called Tommy John Surgery.

The solution is simple but that doesn’t mean it is easy. Dr. Kowalsky recommends the following practices for kids younger than 13 years:

Make time for unstructured play

Keep the ratio of weekly hours of organized sport to free play below 2:1.

Weekly hours of sports participation should not exceed a child’s age, or total of 16 hours in teen players.

Athletes of all ages should participate in some sort of supervised strength and conditioning program.

But he admits, in today’s competitive environment implementation of these steps can be easier said than done. Parents and coaches should keep in mind that the ultimate goal is to make sure their children remain injury-free so they can maximize enjoyment and success in their sport of choice.

Also known as Frozen Shoulder, Adhesive Capsulitis is a common, severely painful condition that leads to stiffness and reduced range of motion in the joint. In the study, Dr. Vadasdi and the research team evaluated the changes in the lining of the joint that contributes to or causes Frozen Shoulder. They discovered an increase in a certain cell type called myofibroblasts, which cause the capsule surrounding the shoulder joint to contact and form scar tissue, leading to pain and increasing stiffness. Steroid injections directly into the joint, however, reduced the increase in myofibroblasts, and helped reverse and prevent progression of the condition.

Frozen Shoulder most commonly affects women between the ages of 40 and 60 years. Most cases of Frozen Shoulder can be resolved non-operatively through stretching, physical therapy, anti-inflammatory medications and cortisone injections. In severe cases, a procedure known as arthroscopic capsular release is performed to break up the adhesions. The findings in Dr. Vadasdi’s study suggest a more rapid resolution of the condition and possibly a decrease in cases needing surgery.

Dr. Vadasdi is an orthopedic surgeon and sports medicine physician who specializes in conditions of the shoulder, knee and elbow. She is the Director of the Women’s Sports Medicine Center at ONS and is a sought after speaker on the topic of women and sports injury and prevention. Her chosen area of medical specialty reflects her personal interests. She is an accomplished triathlete, having completed Ironman competitions in 2007 and 2009. Dr. Vadasdi is also an alpine climber and has ascended Mount Kilimanjaro, Mount Rainier, and the Grand Teton, among others.

Every young athlete dreams of the pride and exhilaration of hitting the game winning home run, or scoring the goal that clinches the championship. In today’s competitive sports environment, youth are under more pressure than ever to train harder and longer to excel in their sport, often with debilitating consequences, writes sports medicine specialist and orthopedic surgeon, Demetris Delos, MD in the latest issue of The Magazine for Greenwich Hospital.

The greatest shift in youth sports in the last generation has been the trend toward sports specialization and year-round training. Twenty years ago, young athletes typically played a particular sport only during that sport’s season (i.e. football in the fall, baseball in the spring and summer), and most kids sat out a season or a summer. Today’s young competitors don’t seem to enjoy that luxury. Unfortunately, this has also led to a surge of sport specific injuries.

The results of this study reflect what orthopedists have noticed in the last decade with the increasing number of kids showing up in our offices with throwing injuries, torn knee cartilage and stress fractures.

Professional level injuries

The growing corps of young adolescents and pre-adolescent baseball pitchers is now throwing excessive numbers of pitches during an unusually high number of innings for immature arm muscles. This has led to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, requiring the so-called Tommy John Surgery. Tommy John was a left handed pitcher for the Los Angeles Dodgers in the 1970’s, who was the first baseball player to undergo UCL reconstruction surgery. His successful recovery and return to achieve a record of 288 career victories.

Anterior cruciate ligament (ACL) tears in youth athletes are also increasing at an alarming rate. While ACL tears are not so closely related to a particular sport statistic the way UCL injuries are tied to pitch count, clearly the rapid rise of sports that involve running and sudden pivoting – think soccer, lacrosse, football, basketball and rugby – increases the likelihood of season ending ACL tears and reconstructive surgery.

Overuse injuries

Unlike ACL injuries, which can be dramatic on-field experiences with players being helped off the field, the vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain. Ironically, these injuries are relatively easy to treat with a period rest and activity modification. All too often, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games. Left untreated, overuse injuries can lead to tears in the muscles and tendons of the affected area, which require a lengthier rehabilitation and sometimes surgery.

Overuse injuries are typically sport specific. In baseball, the upper extremity is most often affected. With Little league shoulder, the growth place of the humerus (arm bone) becomes inflamed by the repetitive motion of throwing with excessive force. Similarly, Little league elbow involves injury to the growth plate along the inner portion of the elbow.

In the lower extremity, overuse injuries of the knee and ankle are very common. Osgood Schlatterand Jumper’s knee are injuries to the growth plate of the knee that can be a frustrating source of pain. These injuries are typically associated with repetitive impact activities (running, jumping, etc.) as seen in basketball, soccer and track. In the ankle, Sever’sdiseasecan lead to pain in the back of the heel.

How can we prevent injuries?

The solution is simple but that doesn’t mean it is easy. Rest and activity modification can be difficult to execute in the middle of the season when the athlete is invested in playing and when parents have already invested much time and money to the sport.

Nevertheless, it is incumbent upon parents to insist their child rest to give the body the opportunity to heal before more serious injury occurs. If a week or two of rest doesn’t resolve the condition, the young athlete should be evaluated by an orthopedist or sports medicine specialist.

Repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. It has been known for some time now that significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

Moreover, there is a growing body of evidence indicating certain sports played excessively during adolescence are associated with the development of femoroacetabular impingement syndrome (hip impingement), which can lead to hip problems often requiring surgery in adulthood.

In addition, numerous studies have shown that exposure in youth to a range of different sports that utilize different muscle groups and mechanical skills lead to the greater overall athleticism and better athletes.

Can chocolate improve athletic performance? Some researchers say it can.

Here’s one more study to suggest that indulging in chocolate and physical fitness are not mutually exclusive. Past research has indicated that flavanols in cocoa beans have antioxidant effects the can help lower blood pressure, improve vascular function and reduce the cell damage involved in heart disease. Now, research published in The Journal of the International Society of Sports Nutrition puts forward the notion that one of the flavanols in the cocoa bean and dark chocolate, epicatechin, can increase the production of nitric oxide in the body. Nitric oxide causes blood vessels to dilate and reduces oxygen consumption, which in turn seems to increase athletic performance.

Nitric acid is also a bi-product of nitrates in beetroot juice, which is popular among elite athletes because it enhances their endurance. A postgraduate research student from Kingston University in London, Rishikesh Kankesh Patel, wanted to know if dark chocolate could provide similar benefits. His supervised study involved nine amateur cyclists who were put into two groups after establishing a baseline in fitness levels. For two weeks, the cyclists replaced a daily snack with 1.5 ounces of chocolate, with one group consuming dark chocolate, the other white chocolate. Following the two weeks, the participants performed moderate cycling exercises and time trials while researchers measured their heart rates and oxygen consumption. The riders then took a week-long break from eating the sweet, then switched chocolate types and repeated the two-week trial and exercises tests.

Patel and his team, noted that after consuming dark chocolate, the athletes used less oxygen when cycling at a moderate pace and out-distanced their white chocolate eating counterparts in a 2-minute time trial. While the results appear promising, more research with a larger study group is needed to determine such factors as the optimal quantity to consume, the time period in which to consume it, and the duration of benefits.

If those questions can be answered, however, dark chocolate may offer a tastier training tool to athletes who find beetroot juice too bitter to palate, and to anyone else looking for a good excuse to each chocolate.

Paul Sethi, MD, was named one of Fairfield County’s Doctors of Distinction by Westfair Communications.

Dr. Sethi, a sports medicine specialist and orthopedic surgeon at ONS, will be presented with the Cutting Edge Award at the annual Fairfield County Doctors of Distinction Awards ceremony on Tuesday, May 3. Dr. Sethi has received this recognition from Westfair Communications for his ongoing research into improving orthopedic surgical procedures and help in creating international orthopedic surgical standards.

As President of the ONS Foundation for Clinical Research and Education, Dr. Sethi’s research has recently included the establishment of better methods for surgical skin preparation (cleaning) to lower the risk of surgical infection; development of a new technique to repair chronic or weakened biceps tendons; and the evaluation of surgical needles in tendon surgery to establish international guidelines on needle use. Additionally, Dr. Sethi has recently contributed a textbook chapter on shoulder fractures, and two chapters on treating elbow injuries in throwing athletes.

The Ortho Access program at ONS offers an added level of safety to young athletes who are injured on the field.

If you missed yesterday’s Well column in The New York Times, it focused on the lack of national safety standards to protect student athletes from crippling or fatal injuries. Individual states and the schools within them, for the most part, haven’t yet adopted injury prevention and treatment policies or procedures for children who play organized or league sports either. The responsibility is all too often left to coaches and parents to assess what measures to take when a young athlete is injured and when they can return to play. 500 student athletes died last year due to poor decisions made immediately following injury, according to the article. The ORTHO ACCESS program at ONS is designed to add an extra layer of medical support and injury prevention education for coaches, athletes, and parents. During the first critical moments after a player is hurt, ONS ORTHO ACCESSsports medicine physicians helps to determine the best immediate course of action to take. Read more.

You can learn about the early days of ONS and the philosophy that made us the most comprehensive and advanced practice the region. The writer, Sara Poirier Correa, did an excellent job explaining that with 22 top sub-specialty trained physicians, ONS is able to provide personalized services to patients. The article also highlights the Women’s Sports Medicine Center and the ONS Foundation for Clinical Research and Education, which has published internationally and competes among researchers at larger universities such as Harvard, Yale, and Johns Hopkins. http://bit.ly/1PNTkfh

Tuesday, Oct 6th, 6 PMFree seminar at Greenwich Hospital

ONS sports medicine specialist Dr. Tim Greene will talk about common causes of chronic hip pain including hip impingement; a painful and often unrecognized condition that involves a tear in the labrum.

Now surgeons can repair labral damage and re-contour bone using hip arthroscopy, a minimally invasive technique that uses two small incisions, a small camera and miniaturized instruments.

Where:

Noble Conference Center
Greenwich Hospital

5 Perryridge Road, Greenwich, CT

Call to register 203-863-4277, or visit www.greenhosp.org.

Tim Greene, MD is a fellowship-trained orthopedic surgeon who specializes in Hip Arthroscopy and Sports Medicine will discuss treatment for hip pain. Dr. Greene graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech. He completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado.

“The USA Rugby National Team lost to Samoa in the first round of the Pacific Nations Cup, 21-16 at Avaya Stadium in San Jose, California. This match was a preview of the match-up between these two teams in pool play for the Rugby World Cup this fall. While the Samoans, ranked 9th in the world they jumped out to an early lead in the first half. The Eagles battled valiantly in the second half, but fell short of victory by only five points.” (more about the game)

Dr. Kowalsky traveled with the team during their week of preparation, and served as team physician for the match. The Eagles contended with a tough Samoan team, known for their physical style of play. Fortunately, neither team sustained catastrophic injuries during the match.

Now back in Connecticut, Dr. Kowalsky looks forward to the fall season of high school, collegiate, and men’s rugby, passing along to athletes these tips for injury prevention strategy:

Adequate nutrition and hydration are imperative not only to optimize performance, but also to avoid overuse injuries during training and competition.

A supervised strength and conditioning program is essential.

Athletes must respond early to symptoms of impending injury when possible, and seek the care of their training staff and team physician.

Dr. Kowalsky is not only team physician for USA Rugby National Team but also for Iona College Rugby Football club and White Plains Rugby Football Club.

KOWALSKY, MD: March 27, 2014; Atlanta, Georgia, USA; USA Men’s Eagles training session before the second leg of the Rugby World Cup 2015 qualifier game against Uruguay at Life University

Rugby is one of the fastest growing sports in the United States, with a 33% annual increase in participation among youth athletes. In part, the popularity of rugby in the US can be attributed to an increased visibility of the sport at the high school and collegiate levels, and the recent success of the USA Rugby National Team. The US fields a “7s” and a “15s” team, characterized by the number of players on the field during competition. The 7s team recently qualified for participation in the 2016 Rio Olympics. This will be the first time the sport is featured in Olympic competition since 1924. The 15s team, otherwise known as the Eagles, is currently ranked 16th in the world, and qualified to compete this fall at the 2015 Rugby World Cup in England.

Orthopaedic & Neurosurgery Specialists have a long-standing tradition of providing orthopedic care for young rugby players. ONS doctors have served as team physicians for the Greenwich High School rugby team, one of the strongest high school teams in the country. Currently, orthopedic surgeon and sports medicine specialist Dr. Marc Kowalsky is the team physician for the USA Rugby National Team. Having played rugby himself at Dartmouth College he understands the game from a medical and player’s perspective. He also serves as team physician for the Iona College Rugby Team and the White Plains Rugby Football Club.

“Injuries that are typically encountered in rugby encompass the entire spectrum of injuries treated in any collision sport. As with American Football, there has been a significant increase in attention to concussion and traumatic brain injury in the sport. World Rugby, the governing body of international rugby, and USA Rugby, have devoted a significant amount of time, energy, and resources to optimize the prevention, detection and care of concussion and traumatic brain injury among rugby players.

Two of the important measures to prevent concussion from occurring are, avoiding contact in the sport at a young age, and proper instruction about safe tackling as contact is introduced. At the elite level, techniques for safe tackling are certainly reinforced. From the perspective of the medical team, all members of the USA Rugby medical staff are required to complete the IRB Level 2 Immediate Care in Rugby Course to prepare for the management of catastrophic injuries during training and competition. Physicians and trainers are additionally required to complete extensive training in the assessment and management of concussion in particular.

Another key tool is a baseline neurocognitive exam to measure an athlete’s cognitive function, or the ability to process information. All players complete neurocognitive testing once they join the team, to establish baseline values for each athlete, which become important in the assessment of an athlete who may have sustained a concussion.”

World Rugby and USA Rugby continue to improve the medical team’s ability to assess injured athletes during competition. Clear guidelines have been established to guide treatment and determine an athlete’s ability to return to play. All of these measures will be in place as the USA Rugby National Team prepares for competition in the Pacific Nation’s Cup, July 18, 2015. Dr. Kowalsky will accompany the team and serve as team physician.

On the evening of June 22, 2015, Orthopedic & Neurosurgery Specialists (ONS) held a grand opening celebration of a second ONS location at 5 High Ridge Park in Stamford, CT. The event was a first look at the new facility for the public, complete with informative stations about injury prevention, exercise tips and sports medicine stations with medical models and video presentations. Throughout the evening, around 200 guests toured the office, and learned about injuries and treatments of the foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine and Platelet Rich Plasma treatment. ONS physicians were available to answer questions. ONS Physical Therapy showcased injury prevention exercises for tennis, golf and running. Local businesses participated in the evening as guests enjoyed food and beverage and displays and a drawing of exciting prizes. The ONS physicians, clinicians and staff members were pleased with the opportunity to meet and greet the Stamford community! To learn more about our new Stamford office please visit https://onsmd.com/ons-stamford/.

Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, CT has opened an expanded, state-of-the-art medical office and physical therapy facility in North Stamford. The new office is conveniently located off the Merritt Parkway at exit 35 at 5 High Ridge Park on the 3rd floor. Patients who choose to see a physician at the new location will find an aesthetically comfortable and healing environment that features the latest technology in imaging and electronic medical records.

A public grand opening celebration, “Your Prescription for Success: A Sports Medicine Event” will take place on June 22nd from 6 to 8 p.m. at the new office located at 5 High Ridge Park, 3rd floor in Stamford.

Exit 35 (CT-137/High Ridge Rd.), go straight at the light at the end of the exit ramp then continue on Buxton Farm Rd. In .7 miles, turn left onto Turn of River Rd. and continue into High Ridge Park. Building 5 is the 2nd building on the left.

Southbound CT-15/Merritt Pkwy:

Take Exit 35 (CT-137/High Ridge Rd.), at end of the ramp, turn right onto High Ridge Road (CT-137). In .1 miles, turn left onto Buxton Farm Road. In .7 miles, turn left onto Turn of River Rd. and continue into High Ridge Park. Building 5 is the 2nd building on the left.

Parking is in the rear of the building

Patient-drop off entrance and handicap accessible parking on lower level

“Arthritis affects more than 52 million adults in the United States and is the most common cause of disability,” according to the CDC. The pain from arthritis can set the stage for a decline in physical activity and make it difficult to prevent chronic health problems. Unfortunately, some who suffer from this ailment stop their activity and become depressed from thoughts of the mobility they once had.

Jane E. Brody, author of the “Keep Moving to Stay a Step Ahead of Arthritis” article in The New York Times recently attempted to relate to those suffering from arthritis by speaking of her own battle with having to put down the tennis racket after decades of enjoying the sport, and her story did not end there. Two years after that, she had joint replacement surgery, picked up an assortment of other activities that successfully replaced tennis as a main source of activity. Therefore, encouraging others to do the same and not succumb to the depression that can sometimes come in hand with arthritis.

The reality is that the majority of people dealing with arthritis do not fully understand what they are capable of. Less than 10% of participants with arthritic knees in a 10-year study met the national guidelines of doing two and a half hours of moderate physical activity a week. Yes, you read that correctly, a week! It gets better though. Participants did notice a significant improvement of function when the amount of activity per week was increased. Additional weight on the body creates unnecessary stress on the major joints as well, leaving a 10% decrease in weight able to make a noticeable difference. With this fact a recommendation of starter exercises were mentioned, including walking laps in a swimming pool and then increasing activity as the muscles gain strength.

We are excited to announce that ONS will open an expanded, state-of-the-art office and physical therapy facility at 5 High Ridge Park in North Stamford in June. Construction began in January and is expected to be completed by the end of May.

The Stamford location will offer a team of physicians and clinical staff dedicated to that office. Some of our other surgeons from Greenwich will also maintain a schedule to see patients in Stamford on a weekly basis. In addition to the doctors’ office, the site will feature a state-of-the-art physical therapy facility outfitted with the latest equipment in an aesthetically comfortable and healing environment.

The new facility is being added in order to accommodate ONS’s growing patient population in the Stamford, New Canaan, Darien and surrounding communities. “Many of our patients come from the Stamford area. Now they can receive the excellent level of orthopedic and neurosurgical care they count on without having to drive to Greenwich,” explained Dr. Seth Miller. In house x-ray and a fully integrated electronic medical records system will make the ONS Stamford office a convenient choice for patients in that area.

ONS specialists are on a mission to spread the word about health! Gloria Cohen, MD participated in the first Collaborative Solutions for Safety in Sport Meeting at the NFL Headquarters in New York City on March 26-27 with more than 20 other members of the AMSSM (American Medical Society for Sports Medicine); an organization of sports medicine physicians in multiple fields dedicated to education, research, and advocacy.

The meeting was strongly influenced by the “2013 Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletic Programs: Best Practice Recommendations” giving it a focus on safety and health issues at the secondary sports level. Speakers encouraged best practices and protocols and this fit perfectly with Cohen’s belief in a comprehensive approach to prevention and treatment of injury. They concerned the establishment with heat-related illnesses, cardiac conditions (use of AEDs), head and neck injuries and the overarching need for emergency action plans in all high schools. ONS would like to thank the participants for understanding how important preventative care is.

Aside from the talk Dr. Cohen is not only a recognized authority in sports medicine, she is a successful competitive runner who has qualified twice for the New York Marathon. She has also held the title as head team physician for the Canadian National Olympic Cycling Team for 14 years while still enjoying off-road and road cycling herself. All in all, we are incredibly proud to have her on our team.

The research in the study noted that the Tommy John surgery is becoming more common, as more pitchers had the surgery in 2014 than in the 90’s combined. Although the success rate of the surgery is high, 20 percent of pitchers never regain a full level of performance even after PT. Other topics covered in the interview include:

What causes tears and the surgeries that follow

Whether it is the arm speed or the pitcher has his forearm cocked that far back